General Anaesthesia; Regional Anaesthesia

Paediatric Anaesthesia - What it is

General Anaesthesia (GA)

General Anaesthesia is administered either by giving medicine through a plastic tube inserted into your child's vein, or gas through a mask or breathing tube. This keeps your child asleep for the duration of surgery or medical procedure. If your child is very anxious or fretful, we may give him/her some sedation beforehand (pre-medication). In addition, we may give painkillers and other medication to facilitate surgery.

Are there any risks from GA?
GA is remarkably safe today, even for a young child. In general, anaesthetic risks depend on your child's medical condition as well as the type of surgery. Side effects are sometimes unavoidable but generally transien.

Common temporary side effects

Headache, dizziness
Nausea and vomiting
Pain or bruising at injection sites
Sore throat
Drowsiness, short term memory loss
Shivering or teeth-chattering
Emergence Delirium: a restless and irritable recovery process during which your child may thrash about, cry or seem inconsolable.
Skin redness or rash from tapes/medication

Uncommon complications

Awareness
Damage to teeth, dental prosthetics, lip or tongue
Damage to vocal cords or larynx
Allergic reactions
Injury to nerves or vulnerable pressure areas
Pressure sores (especially if the surgery is long and involves cardiopulmonary bypass)
Corneal injuries

Extremely rare and serious complications

Severe allergy (anaphylaxis) or shock
Very high temperature (malignant hyperthermia)
Aspiration resulting in lung complications

Fasting guidelines

Our staff will advise you on fasting requirements. If breakfast is allowed, please serve only plain bread, MILO^® or milk. Water may be allowed afterwards. Your child must finish eating or drinking by the stipulated time. You will be informed of the fasting times. Please write down the times given to you below and follow strictly.

During the relaxed anaesthetised state, food and fluid can flow back from the stomach into the mouth and be inhaled into the lungs (known as aspiration) . This can be life threatening. Therefore fasting before anaesthesia is ESSENTIAL and universally practised.

Note: If you do not follow instructions, the procedure may be postponed or cancelled in your child's best interest.

Regional Anaesthesia (RA)

Regional Anaesthesia involves injecting local anaesthetic drug around the nerves that carry pain sensation from the surgical site. This provides pain relief during and after surgery. The exact place where the local anaesthetic drug is injected depends on the surgical site. Your child's anaesthetists will discuss with you which nerve block will work best for your child, as well as potential risks associated with it Depending on the age and medical condition, RA can be performed awake, or more commonly under GA or sedation in children.

Common types of regional anaesthesia include:

A. Peripheral block: e.g. Penile Nerve, Ilioinguinal Nerve, Brachial Plexus, Femoral Nerve

B. Central block: e.g. Epidural, Caudal or Spinal Anaesthesia

In epidural anaesthesia, a special needle guides the placement of a fine bore tubing (catheter) into a space near the spine between the backbones. Continuous pain relief can be achieved by administering local anaesthetic and painkillers via this catheter. This catheter may be left in place up to several days after surgery. This allows for continued post-operative pain relief. Caudal anaesthesia is essentially epidural anaesthesia given at the bottom of your child's spine. It can be given as a single injection or repeated at the end of surgery. Alternatively, a catheter may be left in place like in an epidural.

Are there any risks?

It may take several hours for the effects of regional anaesthesia to wear off. As the anaesthetised site is numb, extra care should be taken to avoid accidental injury. Where central blocks or ilioinguinal nerve blocks are used, your child should not ambulate until the numbness has subsided and strength regained in the legs. Rarely, the nerve blocks may fail or result in an incomplete patchy block.

Common side-effects (usually temporary) of central blocks

Numbness or tingling sensation in lower limbs
Weakness of muscle over numbed areas
Shivering
Itching
Backache and bruising over injection site
Inability to pass urine
Dizziness, headache
Drop in blood pressure (uncommon in children)

Serious but rare side effects

Trauma to surrounding structures
Nerve damage
Blood clot (Haematoma)
Seizures
Breathing difficulties
Infection, abscess formation
Cardiac arrest

Invasive Monitoring

Invasive Monitoring may be required if your child is critically ill or undergoing major surgery.

Arterial line

Arterial line involves placement of a plastic catheter into an artery for accurate monitoring of your child's blood pressure. Blood can also be drawn from the line for tests if necessary. Complications may include injury to the vessel/surrounding structures and blood clot.

Central venous line (CVL)

A large bore catheter is inserted through your child's neck, chest or groin into a la;ge vein leading to the heart so that we can assess your child's blood volume and heart function better. The central venous line also allows for the administration of drugs and fluids as required. Complications may include inadvertent puncture of the artery or lung, blood clot formation or heart rhythm changes. Very rare complications include nerve injury, damage to the thoracic duct and migration of the catheter out of the vein. In extremely rare cases, some of these complications may be fatal.

Post-operative special care: Children's Intensive Care (CICU), High Dependency

Post-operative intensive care may be required in cases where intensive monitoring, ventilatory support or cardiovascular support is needed.

High dependency monitoring is necessary for children who require closer monitoring or care after surgery as compared to patients in the general ward.

High-risk patients: the critically-ill or extremely young babies

In a critically-ill child, the risk of peri-operative complications and death is vastly increased. The benefits of anaesthesia need to be weighed against the risks and this balance varies from patient to patient. Your anaesthetist will advise you on the appropriate peri-operative care for your child after a discussion with you and the surgical team.